Invasive fungal disease in humans: are we aware of the real impact?

Despite the medical advances and interventions to improve the quality of life of those in intensive care, people with cancer or severely immunocompromised or other susceptible hosts, invasive fungal diseases (IFD) remain severe and underappreciated causes of illness and death worldwide. Therefore, IFD continue to be a public health threat and a major hindrance to the success of otherwise life-saving treatments and procedures. Globally, hundreds of thousands of people are affected every year with Candida albicans, Aspergillus fumigatus, Cryptococcus neoformans, Pneumocystis jirovecii, endemic dimorphic fungi and Mucormycetes, the most common fungal species causing invasive diseases in humans. These infections result in morbidity and mortality rates that are unacceptable and represent a considerable socioeconomic burden. Raising the general awareness of the significance and impact of IFD in human health, in both the hospital and the community, is hence critical to understand the scale of the problem and to raise interest to help fighting these devastating diseases.

Nursing team knowledge on care for patients with fungating wounds / Conocimiento del equipo de enfermería sobre cuidados con pacientes con úlceras neoplásicas / Conhecimento da equipe de enfermagem sobre cuidados com pacientes com feridas neoplásicas

ABSTRACT Objective: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. Method: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher's exact test, Student's t-Test and Pearson's correlation. Results: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. Conclusion: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.

RESUMEN Objetivo: evaluar el conocimiento del equipo de enfermería de un hospital oncológico sobre el cuidado de pacientes con Úlceras Neoplásicas Malignas (UNM) y analizar factores sociodemográficos y educativos asociados. Método: estudio observacional y transversal, realizado entre septiembre y octubre de 2015, tras la aprobación por el Comité de Ética en Investigación. Se aplicó un cuestionario que contenía componentes sociodemográficos, educativos y relacionados con la realización de curativos, elección de coberturas y orientación. Los datos fueron analizados a través del Test Qui-Cuadrado, Exacto de Fisher, Test t de Student y correlación de Pearson. Resultados: en el estudio 37 profesionales, siendo la mayoría técnicos (56,8%), mujeres (91,9%) y con edad media de 32 años. Los profesionales presentaron un 56,5% de aciertos. No hubo asociaciones estadísticamente significativas entre variables sociodemográficas/educativas y número de aciertos. Conclusión: se observó déficit de conocimientos importantes sobre el cuidado de pacientes con UNM, lo que debió orientar estrategias para capacitación de los equipos actuantes en Oncología.

RESUMO Objetivo: avaliar o conhecimento da equipe de enfermagem de um hospital oncológico sobre o cuidado de pacientes com Feridas Neoplásicas Malignas (FNM) e analisar fatores sociodemográficos e educacionais associados. Método: estudo observacional e transversal, realizado entre setembro e outubro de 2015, após aprovação por Comitê de Ética em Pesquisa. Foi aplicado questionário contendo componentes sociodemográficos, educacionais e relacionados à realização de curativos, escolha de coberturas e orientação. Os dados foram analisados por meio do Teste Qui-Quadrado, Exato de Fisher, Teste t de Student e correlação de Pearson. Resultados: participaram do estudo 37 profissonais, sendo a maioria técnicos (56,8%), mulheres (91,9%) e com idade média de 32 anos. Os profissionais apresentaram 56,5% de acertos. Não houve associações estatisticamente significativas entre variáveis sociodemográficas/educacionais e número de acertos. Conclusão: observou-se déficit de conhecimentos importantes sobre o cuidado de pacientes com FNM, o que deve nortear estratégias para capacitação das equipes atuantes em Oncologia.

Monetary costs and hospital burden associated with the management of invasive fungal infections in Mexico: a multicenter study

ABSTRACT Background: Invasive fungal infections (IFIs) affect >1.5 million people per year. Nevertheless, IFIs are usually neglected and underdiagnosed. IFIs should be considered as a public-health problem and major actions should be taken to tackle them and their associated costs. Aim To report the incidence of IFIs in four Mexican hospitals, to describe the economic cost associated with IFIs therapy and the impact of adverse events such as acute kidney injury (AKI), liver damage (LD), and ICU stay. Methods: This was a retrospective, transversal study carried-out in four Mexican hospitals. All IFIs occurring during 2016 were included. Incidence rates and estimation of antifungal therapy's expenditure for one year were calculated. Adjustments for costs of AKI were done. An analysis of factors associated with death, AKI, and LD was performed. Results: Two-hundred thirty-eight cases were included. Among all cases, AKI was diagnosed in 16%, LD in 25%, 35% required ICU stay, with a 23% overall mortality rate. AKI and LD showed higher mortality rates (39% vs 9% and 44% vs 18%, respectively, p < 0.0001). The overall incidence of IFIs was 4.8 cases (95% CI = 0.72-8.92) per 1000 discharges and 0.7 cases (95% CI = 0.03-1.16) per 1000 patients-days. Invasive candidiasis showed the highest incidence rate (1.93 per 1000 discharges, 95% CI = −1.01 to 2.84), followed by endemic IFIs (1.53 per 1000 discharges 95% CI = −3.36 to 6.4) and IA (1.25 per 1000 discharges, 95% CI = −0.90 to 3.45). AKI increased the cost of antifungal therapy 4.3-fold. The total expenditure in antifungal therapy for all IFIs, adjusting for AKI, was $233,435,536 USD (95% CI $6,224,993 to $773,810,330). Conclusions: IFIs are as frequent as HIV asymptomatic infection and tuberculosis. Costs estimations allow to assess cost-avoidance strategies to increase targeted driven therapy and decrease adverse events and their costs.

Disseminated mycosis in a patient with yellow fever

Disseminated mycosis (DM)­with cardiac involvement and shock­is an unexpected and severe opportunistic infection in patients with yellow fever. DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing. We report the case of a 53-year-old male patient who presented to the emergency department with fever, myalgia, headache, and low back pain. The laboratory investigation revealed a positive molecular test for yellow fever, hepatic injury, and renal failure. During hospitalization, the patient developed hepatic encephalopathy, ascending leukocytosis, and ascites, with signs consistent with peritonitis. On the 11th day of hospitalization, the patient developed atrioventricular block, shock and died. At autopsy, angioinvasive mycosis was evidenced mainly in the heart, lungs, kidneys, and adrenals.

Micosis invasivas agudas: presentaciones atípicas / Acute invasive mycosis: atypical presentations / Micose invasiva aguda: apresentações atípicas

INTRODUCCIÓN: Las micosis invasivas agudas son infecciones rápidamente progresivas con una alta tasa de morbimortalidad. Se presentan principalmente en pacientes neutropénicos. La neutropenia puede clasificarse en cuantitativa (en neoplasias hematológicas, SIDA, inmunodepresión secundaria a transplantes) o cualitativa (en diabéticos mal controlados). Existen dos formas de presentación: Rinosinusal y extrasinusal. En esta última se describen tres subtipos: Rinoorbitaria (mayor frecuencia), rinocerebral y de partes blandas cervicofaciales. OBJETIVO: Describir dos casos clínicos de pacientes con presentaciones atípicas en las micosis invasivas agudas.

INTRODUCTION: Acute invasive mycosis can be a rapidly progressing infection that exhibits high rates of morbidity and mortality. Most commonly occurs in individuals with hematologic malignancies, particularly in patients who have received bone marrow transplantation. Other compromised patient populations at risk are those on chronic steroids, poorly controlled diabetics, patients with AIDS, and those undergoing chemoradiation therapy. Presentation forms can be rinosinusal and extrasinusal, this last one divided into: Rhinorbital, rhinocerebral and soft tissue affectation. OBJECTIVE: Describe two clinical cases of atypical presentation of acute invasive mycosis.

INTRODUÇÃO: Infecções fúngicas invasivas agudas são rapidamente progressivas, com alta taxa de morbidade e mortalidade. Eles ocorrem principalmente em pacientes neutropênicos. A neutropenia pode ser classificada como quantitativa (em neoplasias hematológicas, AIDS, imunossupressão secundária a transplantes) ou qualitativa (em diabéticos pouco controlados). Existem duas formas de apresentação: Rinossinusal e extrasinusal. Neste último, são descritos três subtipos: rino-orbitário (maior freqüência), tecido mole cervicofacial e rinocerebral. OBJETIVO: Descrever dois casos clínicos de pacientes com apresentações atípicas em micoses invasivas agudas e realizar uma revisão bibliográfica da referida patologia.